Depression and Anxiety Linked to Migraine Disability

Depression and anxiety are often present in patients with migraine, especially those with chronic migraine. Some studies even suggest a common genetic link between depression and migraine. Many of us who live with migraine have suggested that the challenges of living with the condition contribute to the development of depression and anxiety. Now there is evidence that even mild depressive or anxiety symptoms can have a significant impact on Migraine.

Study objective

This studyexamined the relationship between chronic migraine and migraine-related disability and the psychological factors of depression, anxiety, maladaptive thought patterns, and migraine-related beliefs.

Study methods

Ninety participants with a confirmed migraine diagnosis from a headache specialty clinic were surveyed using the following self reporting questionnaires:

Headache Specific Locus of Control (HSLC) assessed the extent to which participants believed their migraines are influence by their own actions, the actions of their doctor, or fate/chance.

Study results

Migraine

36 percent had chronic migraine.

51.5 percent had severe migraine-related disability.

Depressive symptoms

Average PHQ-9 score was “mild” depression severity.

56.6 percent had no or minimal depressive symptoms.

21.3 percent had mild symptoms.

22.2 percent had moderate to severe symptoms.

Increased depressive symptoms were associated with both chronic migraine and migraine-related disability.

Anxiety symptoms

Average score was none or minimal symptoms.

Two-thirds had none or minimal symptoms.

21.7 percent had mild symptoms.

10.8 percent had moderate to severe symptoms.

Not associated with chronic migraine

Associated with migraine-related disability

Pain catastrophizing

Not associated with chronic migraine

Associated with migraine-related disability

Headache-specific locus of control

Patients reporting chance locus of control (belief that nothing can control migraine) were more likely to report chronic migraine.

No association with migraine-related disability

Study conclusions

Depression and anxiety

Higher rates of depressive and anxiety symptoms were associated with increased migraine-related disability.

Even small increases in these symptoms were associated with increased frequency and disability.

Migraine patients with depression are at higher risk of developing chronic migraine.

Treating these symptoms in addition to migraine treatment often results in significant improvement of migraine symptoms.

Pain catastrophizing

Pain catastrophizing was associated with migraine-related disability

Study was not designed to determine if catastrophizing caused disability. It is just as likely that severe migraine-related disability contributes to catastrophizing or some other factors are involved.

Treatment for symptoms of depression and anxiety also address these thought patterns.

Future interventions could emphasize treatment of depression and anxiety in general rather than focusing on only catastrophizing.

Headache-related locus of control

Chronic migraine was associated with patient reports of belief that nothing can control migraine attacks.

Authors state that this association may be due to the relative difficulty of trigger identification common in chronic Migraine.

Previous studies suggest that such beliefs are associated with maladaptive coping strategies.

Authors note that is quite possible this belief plays minimal or no role in the migraine symptoms and recommend further studies to examine any associations between the two.

Other study observations

Because the participants were seen at a migraine clinic, the results of this study may not represent the experience of migraine patients in general.

Gaining an understanding of the psychological factors associated with migraine-related disability could improve treatment of those most disabled by migraine.

The participants were mostly middle-aged, well-educated, insured, white women. Their reported experiences may not apply to other patient groups.

The anxiety screening questionnaire only assessed symptoms of Generalized Anxiety Disorder. Patients with other anxiety disorders may not have the same experiences reported by the study participants.